Massive Bleeding from an Ileal Conduit Caput Medusae

Abstract

A caput medusae developing around an ileal conduit stoma heralded the onset of portal hypertension and recurrent episodes of massive stomal bleeding in a patient with liver cirrhosis. A review of the literature suggests that conservative local measures remain the treatment of choice in the high risk cirrhotic patient.

A case of fatal cutaneous caput medusae hemorrhage

“…Treatment of this condition includes standard resuscitation protocols as an initial approach in order to obtain hemodynamic stabilization with local measures to control the bleeding during the resuscitation, such as direct pressure, suture ligation, or cautery. [20][21][22] Other measures in the management of caput medusae hemorrhage are the correction of coagulopathy and the reduction of portal hypertension. Coagulopathy in liver disease results from thrombocytopenia and impaired humoral coagulation.…”

Stomal Varices Manifestation of Portal Hypertension in Advanced Intestinal Failure–associated Liver Disease

“…In primary liver disease with portal hypertension, portosystemic collaterals develop, usually first at the gastroesophageal junction. They may also later develop at unusual sites such as the anorectal junction, gallbladder, urinary bladder, uterus, vagina, umbilicus, retroperitoneum (3), colostomies, ileostomies, and ileal conduits (4–7). Surgery leading to apposition of bowel to the abdominal wall leads to the development of varices at ectopic sites, more so in the presence of intrahepatic cause of portal hypertension.…”

Life‐threatening haemorrhage from an ileal conduit

“…Parastomal bleeding is commonly caused by poorly fitting urostomy devices and exposure of the skin to irritant urine. Massive haemorrhage from varices because of portal hypertension is rare [1–3], and is extremely distressing for the patient and family. Initially urological causes, including malignancy, must be excluded.…”